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The
Vital Vitamin -- Oral B12 Equivalent to InjectionsReprinted
by permission from Bill Faloon of The Life Extension Foundation

by Terri Mitchell

Methylcobalamin
is the form of vitamin B 12 active in the central nervous system.
It is an active coenzyme of the vitamin B12 analogs, that are
essential for cell growth and replication. The liver may
not convert cyanocobalamin, the common supplemental form of
vitamin B 12, into adequate amounts of
methylcobalamin
the body may need for proper neuronal functioning.
Methylcobalamin
may exert its neuroprotective effects through enhanced methylation,
acceleration of nerve cell growth or its ability to promote
healthy
homocysteine levels. For
methylcobalamin
to be available to the brain, it should be allowed to dissolve
under the tongue in order to bypass the liver during first pass
through the blood stream.

For decades, people have been injecting themselves with vitamin
B12 because they thought oral supplements were not adequately
absorbed. New research indicates that oral B12 supplements
may be as good or better than injections.

Those who have low levels of vitamin B12 in
the blood have long resorted to injections of this essential B
vitamin, an uncomfortable delivery method at best. New
evidence suggests that oral B12 works as well as injections,
according to a study published in the journal Blood
but high doses must be taken. This verifies reports from
Sweden dating from the 1970s. Resolving the debate over
oral-versus-injections is very timely, given that vitamin B12 is
a homocysteine-lowering factor.

According to the recent data, 2,000 micrograms (2
mg) per day of oral B12 is necessary. The oral version works as well as injections, with
the added feature of maintaining high levels in the blood over time. The study
showed that after a month, the blood levels of the vitamin in people receiving
injections dropped and stayed at a plateau, whereas blood levels of those
receiving oral B12 continued to rise.

B12 Lowers HomocysteineAlthough oral B 12 did not reduce homocysteine (high levels is a marker of
poor health) in
every case, when it did, the results were dramatic. Some of the people in the
study had homocysteine levels as high as 175 micromoles per liter (the optimal
safe range for homocysteine is under 6). In the case of one patient, 2,000
micrograms of oral B12 for four months reduced their homocysteine from 113.4
micromoles per liter to 8.2. Injected B 12 also significantly reduced
homocysteine - the main difference being that the injected version worked
faster.

Interestingly, some of the patients did not
respond to supplemental vitamin B12. It was discovered that they were also
deficient in folate (folic acid), and until folate was
replaced, their homocysteine remained elevated. Vitamin B12 and folate work
synergistically in the chemical reactions that recycle homocysteine back to
methionine in the methylation cycle. It is also interesting to note that
participants in the study with both B12 and folate deficiencies had several
health problems including those related to
alcohol consumption. This is probably due to the vitamin's role in methylation.

"Intrinsic factor" is a type of protein that is secreted by the stomach to
help the body absorb B12. Older people produce less intrinsic factor, and are
thus more vulnerable to B 12 deficiency. In the study mentioned at the beginning
of this article, high-dose sublingual B12 was absorbed as well as injectable. No
supplemental intrinsic factor was given. Insufficient stomach acid can be
the result of low intrinsic factor. Injected B12 has traditionally been used because it bypasses the absorption problem.

Different Forms of Vitamin B12Cyanocobalamin is the usual form of B 12 sold in
this country in tablets or capsules that you swallow. Hydroxocobalamin and adenosylcobalamin are two other forms.
For
the past 20 years, English doctor Anthony G. Freeman has been attempting to get
the cyano form of B12 removed from the market and replaced with the
hydroxocobalamin. He points out that the cyano form is not effective for certain
eye problems caused by smoking and alcohol. But another form, methylcobalamin,
may be the best of all. Research shows that this active form of B 12 has the
unique ability without adverse side
effects.

It has been documented that the level of B12
decreases every year with age. They also have less
SAMe
(s-adenosylmethionine)
- the substance required to methylate cobalamin or
cyanocobalamin (the kind of B12 found in most tablets/capsules and/or multi-formulas) to methylcobalamin, the
active form. Methylcobalamin is already methylated -- it doesn't require
SAMe.

The ElderlyB12
deficiency is a fairly common deficiency in elderly people. It is crucial for the retention of folate
(folic acid) in cells. Diet, age, and drugs are the prime culprits
behind B12 deficiency. Meat is the primary source of vitamin B12. Strict
vegetarians (people who eat no animal products whatsoever) are at risk for vitamin
B12 deficiency. (Vegetarians who eat eggs and fish will get B12 in their
diet. In addition, some seaweeds contain the vitamin, and the gut may
manufacture a certain amount.) However, a meat diet doesn't guarantee that a
person won't be B12 deficient. Some elderly people, for example, can eat high
quantities of meat but still be B12 deficient because they don't have enough
hydrochloric acid in their stomach to maintain a protein called "intrinsic factor." Meat-eaters
taking certain drugs are also at risk for B12 deficiency. Cimetidine (Tagamet), Metformin,
omeprazole (Prilosec), and other drugs that inhibit gastric secretion can
cause B12 deficiency. Anyone who chronically takes drugs for
stomach ulcers,
"heartburn" or gastroesophageal reflux may be creating B12
deficiency in themselves.

There appears to be something else causing B12
deficiency in older people that researchers don't yet understand. In a Dutch
study, researchers found that about 25% of the participants had low vitamin B
12. But
gut problems only accounted for 28% of those cases. The cause in the remaining
72% was a mystery. Researchers do know that more people may be deficient than
currently appreciated. When researchers at the Veterans Administration
Hospital in Oklahoma used modified criteria for B12 deficiency (elevations in
homocysteine and methylmalonic acid, plus serum B 12 up to 300 pg/mL -- the norm
is usually 200), they uncovered twice as many people with B12 deficiency than
would have been detected by serum values alone.

Elevated homocysteine levels (a marker of poor
health) is found in many people with compromised health. When treated
with 1000 micrograms (1mg) of vitamin B 12 (methylcobalamin) daily for three weeks,
homocysteine levels dropped significantly. Although the study didn't follow
the patients long enough to see the effects of long-term treatment, the
condition of the patients' blood vessels will likely improve as the levels of
homocysteine are reduced, as homocysteine is extremely toxic.

B12 and Sleep SupportThose who have a hard time sleeping may need
vitamin B 12. Studies show that B12 causes an earlier release of
melatonin
at night which supports the sleep-wake cycle. B12 acts
directly on the pineal gland to provoke a faster release of melatonin. B12 helps you get to sleep earlier and may help you wake up earlier especially if you leave a curtain open to the
morning sun. B12 sensitizes you to morning light which helps you wake up.
However, it may not work for everyone. Unfortunately, the vitamin doesn't help people who want to cut down on their
sleep time altogether.

Testing for B12 DeficiencyThere are several tests geared towards
diagnosing B12 deficiency. Checking your blood for Homocysteine levels is an indirect test. A more direct
method is to measure methylmalonic acid which becomes elevated in B12
deficiency. There are other tests which measure gut secretions or antibodies
to gut secretions. The
Schilling Test can help ferret out what is causing the deficiency, and a
simple blood test can show blood levels.

DosageThe dose of oral B12 supplements for sleep
support is 3000 mcg (3mg) a day, while 2000 mcg (2mg) a day has proven useful in
lowering homocysteine and correcting B12 deficiency. In published studies, it
took four weeks for sleep support, and four months for the homocysteine-lowering
effect -- so, be patient. People with more serious issues should take very high doses in the range of
3000-5000mcg,
supplemented with SAM-e (s-adenosylmethionine).

The neurologically active form of vitamin B 12
(methylcobalamin), is the recommended form to consume. The potential benefits are well-worth the modest price.
It is the methylcobalamin form of
B12 that has been used in most European and Japanese studies showing efficacy. The liver converts about 1% of ingested
cyanocobalamin into methylcobalamin, but it is far more efficient to dissolve
a good tasting methylcobalamin lozenge in the mouth for immediate
assimilation into the brain.

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